Supplements and Sports Foods
Supplements and sports foods represent a lucrative industry that takes advantage of strong marketing to athletes and people who exercise, while also reflecting the community interest in supplements.
The use of supplements and sports foods by athletes involves a balance between the potential benefits (e.g. contribution to an evidence-based sports nutrition program) and potential risks (e.g. waste of resources, distraction, poor role modelling, anti-doping rule violations, adverse health events). Although many sports agencies still provide a blanket warning against the use of supplements in view of these concerns, there is a movement towards a more pragmatic approach. This approach requires the athlete to make a considered decision when contemplating the use of a supplement/sport food:
- Is it safe?
- Is it permitted in sport?
- Is there evidence that it “works” (i.e. is there evidence that it will provide a meaningful benefit?)
The 2018 consensus statement on supplements and the high-performance athlete by the International Olympic Committee (IOC) provides a summary of the challenges faced by the high performance athletes, coaches and support staff when considering the use of supplements.
IOC consensus statement: dietary supplements and the high-performance athlete
Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, Rawson ES, Walsh NP, Garthe I, Geyer H, Meeusen R, van Loon LJC, Shirreffs SM, Spriet LL, Stuart M, Vernec A, Currell K, Ali VM, Budgett RG, Ljungqvist A, Mountjoy M, Pitsiladis YP, Soligard T, Erdener U, Engebretsen L.
Br J Sports Med. 2018 ;52(7):439-455. doi: 10.1136/bjsports-2018-099027
Nutrition usually makes a small but potentially valuable contribution to successful performance in elite athletes, and dietary supplements can make a minor contribution to this nutrition programme. Nonetheless, supplement use is widespread at all levels of sport. Products described as supplements target different issues, including (1) the management of micronutrient deficiencies, (2) supply of convenient forms of energy and macronutrients, and (3) provision of direct benefits to performance or (4) indirect benefits such as supporting intense training regimens. The appropriate use of some supplements can benefit the athlete, but others may harm the athlete's health, performance, and/or livelihood and reputation (if an anti-doping rule violation results). A complete nutritional assessment should be undertaken before decisions regarding supplement use are made. Supplements claiming to directly or indirectly enhance performance are typically the largest group of products marketed to athletes, but only a few (including caffeine, creatine, specific buffering agents and nitrate) have good evidence of benefits. However, responses are affected by the scenario of use and may vary widely between individuals because of factors that include genetics, the microbiome and habitual diet. Supplements intended to enhance performance should be thoroughly trialled in training or simulated competition before being used in competition. Inadvertent ingestion of substances prohibited under the anti-doping codes that govern elite sport is a known risk of taking some supplements. Protection of the athlete's health and awareness of the potential for harm must be paramount; expert professional opinion and assistance is strongly advised before an athlete embarks on supplement use.
Minimising Risk From Performance Supplements: An Athlete’s Guide
As per advice from the Australian Sports Anti-Doping Authority (ASADA), no supplement is 100% safe to use and most supplements do not actually improve performance. It is important that all athletes are aware of the risks involved in taking supplements, therefore the Australian Institute of Sport (AIS) has put together an athlete guide to assist in their decision making. The AIS believes athletes should not take any supplements without first consulting their Sports Doctor or Accredited Sports Dietitian.
The AIS Sports Supplement Framework 2019
The AIS Sports Supplement Framework provides the expertise and resources developed during the implementation of the AIS Sports Supplement Program (2000-2013) to allow National Sporting Organisations (NSOs), the National Institute Network and other system partners to develop their own Sports Supplement Guidelines and Programs. These resources are shared via open access to help athletes, coaches and scientists to make evidence-based decisions about their use of supplements and sports foods.
The Supplement Framework is underpinned by the ABCD Classification system
The ABCD Classification system ranks sports foods and supplement ingredients into four groups according to scientific evidence and other practical considerations that determine whether a product is safe, permitted and effective in improving sports performance.
The current classification of supplements and sports foods was made via the consensus of the AIS Sports Supplement Framework working team, and will constantly evolve according to new knowledge plus the informed direction of our key stakeholders.
- The ABCD Classification system focuses on sports foods and individual ingredients rather than specific supplement products and brands.
- Multi-ingredient supplements (e.g. pre-workouts) raise specific concerns. These products contain a large list of individual ingredients and, in some cases, the doses of these ingredients are not stated on the label with the excuse that it is a “proprietary blend” over which the manufacturer has special ownership. Concerns about these products include the lack of an effective dose (e.g. inadequate amounts or poor timing of intake relative to exercise) of some active ingredients, potential for harmful interactions between ingredients, and the increased risk of inadvertent contamination due to the sourcing of ingredients from various locations.
The Evidence Map
The aim of the AIS Sports Supplement Framework Evidence Map is to provide a more sophisticated understanding of the range of small, but sometimes important, roles by which supplements and sports foods might contribute to an athlete’s sports nutrition plan. The Evidence Map is an evolving platform which identifies different characteristics of an athlete’s health and performance that could be addressed by different products or ingredients, as well as the strength of evidence for their use. The evidence for beneficial applications of supplements and sports foods is integrated with the larger issues of safety, permitted uses in sport and a “food first” philosophy. Continue to visit this site as the Evidence Map and its resources grow.
Three special features are noted:
- A series of emojis rate the level of evidence or concern associated with supplements and their application to targeted issues within the athlete’s health and performance goals. We also identify issues around integrating a product/ingredient into the athlete’s sports nutrition plan and the role of a sports nutrition expert in assisting with this process
- We have used a “wisdom of the crowd” process to decide on the emoji rating – we have assembled a network of experts on sports nutrition on whom we call on to develop these ratings
- The Evidence Map will host a growing series of resources that provide further information around many issues of sports nutrition, including the specialised role of sports foods and supplements
We hope that this Evidence Map will help athletes to improve their knowledge and practice of sports nutrition, including making informed decisions about whether supplements and sports foods are part of the toolbox.
